الفهرس 
AANNAATTOOMY OOFF TTHEE AADDREENNAALL GGLLAANNDDSSOnly 14 pages are availabe for public view
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Abstract
The new gold standard;-
After a decade of worldwide experience, laparoscopic adrenalectomy has successfully passed its ”definition” phase and achieved maturation. Laparoscopic adrenalectomy is well-established technique and is currently the treatment of choice for benign functioning and nonfunctioning neoplasms of the adrenal gland. The limited experience with the procedure in malignancy shows some promise, but its role is yet to be clarified. Currently, invasive adrenocortical carcinoma and metastatic pheochromocytoma to periaortic nodes are the only absolute contraindications. Only experienced laparoscopic surgeons should attempt laparoscopic resection of large masses and, generally, the minimally invasive technique is not advisable for lesions greater than 12 to 14 cm(Gagner M.& Assalia A.,2005).
The accumulated evidence indicates that laparoscopic adrenalectomy in patients with hormonally active tumours is the new gold standard. This minimally invasive technique has become the procedure of choice for hyperaldosteronism, Cushing’s syndrome and disease, and pheochromocytoma. (Fernandez-Cruz et al,2002).
Bilateral laparoscopic adrenalectomy appears to be safe and effective in patients with pituitary-dependant Cushing’s syndrome after failed transsphenoidal surgery and in cases with ectopic ACTH syndrome when the primary tumour cannot be identified or removed. (Vella A. et al, 2001).
It is now obvious that laparoscopic resection of pheochromocytomas can be accomplished safely despite frequent episodes of hemodynamic variability equal to those of historical open control subjects. The earlier recovery, fewer complications, and lack of endocrine recurrence make this approach the procedure of choice for the management of pheochromocytoma.(Kercher K.W. et al,2002).
In addition, a recent publication by Brunt and colleagues had reported favourable results in cases of unilateral and bilateral familial pheochromocytoma(patients with MEN2A, MEN2B, Von Hippel- Lindau disease, and neurofibromatosis type 1). Another large series from Germany has documented the successful outcome of endoscopic approach in 61 chromaffin neoplasms(52 pheochromocytomas and 9 paragangliomas).The patient population included a wide spectrum of this disease: unilateral, hereditary, bilateral, recurrent, and multiple tumours. (Walz M.K. et al,2002).
In patients with bilateral disease, partial bilateral adrenalectomy was performed and achieved preservation of adrenocortical function in 86% of cases, without evidence of recurrence after 3 years of follow-up. Thus, in patients with hormonally active tumours of the adrenal, the procedure has proved feasible and safe and offered all the advantage of minimally invasive surgery. Additionally, it resulted in an excellent functional outcome and was associated with clinical and biochemical cure rates comparable with those of open surgery during long-term follow-up.(Gagner M. et al,1997).